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Ryo Baba, Kazuhiko Umazume, Hiroshi Goto; Absence of posterior vitreous detachment as a possible risk factor of severe bleb-related endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6184.
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Bleb-related endophthalmitis (BRE) after glaucoma surgery is an infection caused by bacteria in the avascular bleb gaining access into the eye. We report the clinical features and outcome of eyes with severe BRE treated at our hospital.
Ten patients (10eyes) with stage IIIb BRE after trabeculectomy diagnosed and treated at the Department of Ophthalmology, Tokyo Medical University Hospital between April 2013 and May 2015 were studied. Patient background, type of glaucoma, interval from the first trabeculectomy to the onset of BRE, bleb findings before onset of BRE, surgical procedure, status of posterior vitreous detachment (PVD) confirmed during vitrectomy, and postoperative visual acuity were retrospectively reviewed by medical chart.
The 10 patients comprised 8 males and 2 females, with mean age of 70.6 years at BRE onset. The types of glaucoma were open angle glaucoma in 7 patients, neovascular glaucoma in 2, and secondary glaucoma associated with uveitis in 1. All eyes underwent trabeculectomy combined with mitomycin C. The interval from the first glaucoma surgery to the onset of BRE was 8.5 ± 4.1 years. All eyes revealed leakage of aqueous humor from the avascular bleb before onset of BRE. BRE was treated by vitrectomy in 9 eyes, and enucleation in 1 eye. In 6 eyes underwent vitrectomy with induction of PVD. Histopathological examination of the enucleated eye showed no PVD. Decimal visual acuity improved by 3 lines or more in 6 patients and remained lower than 0.1 in 4 patients.
BRE developed frequently in eyes with no PVD. The absence of PVD may be a risk factor of severe BRE.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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